Readmission following total knee arthroplasty: venous thromboembolism as a "never event" is a counterproductive misnomer.

Abstract

A national quality improvement initiative identifies certain avoidable complications as "never events," and includes venous thromboembolism (VTE). This study examines the incidence and cost of VTE following total knee arthroplasty (TKA) compared to other causes of readmission and the degree to which VTE was preventable. One hundred twenty-one readmissions (105 patients) were reviewed to determine the reason for readmission, cost, and compliance with SCIP VTE prophylaxis guidelines. The most common reasons for readmission were limited motion (18.2%), wound complication (14%), surgical site infection (9.9%), and bleeding (9.9%). VTE was less common (3.3%), and all occurred despite adequate prophylaxis. The cost of bleeding, wound complications, infection, and limited motion each exceeded the cost of VTE. These results challenge the identification of VTE as a "never event."